Massive fetomaternal hemorrhage: A case report

Abstract

We present a case with an incidental finding of abnormal cardiotocography (CTG) pattern as well as elevated middle cerebral artery peak systolic velocity (MCA-PSV) in an otherwise inconspicuous pregnancy. Massive fetomaternal hemorrhage (FMH) was detected as the cause by flow cytometry (FC), resulting in multiple cycles of fetal blood sampling (FBS) showing severe anemia, intrauterine transfusions (IUTs), a preterm delivery, and a healthy infant in follow-up examinations.

Zusammenfassung

In diesem Case Report berichten wir von einem Fall mit einem Zufallsbefund eines pathologischen Cardiotokogramm (CTG)-Musters und erhöhter MCA-PSV des Fetus bei einer ansonsten unauffälligen Schwangerschaft. Durch Flow Cytometry (FC) wurde eine Fetomaternale Makrotransfusion diagnostiziert und mehrere Zyklen von intrauterinem blood sampling (FBS) mit dem Ergebnis schwerer fetaler Anämie durchgeführt. Wiederholte intrauterine Transfusionen (IUT) sowie eine vorzeitige Entbindung resultierten in einem gesunden Kind.

Keywords

Fetomaternal haemorrage - Fetal anaemia - Intrauterine transfusion - Fetal blood sampling

Schlüsselwörter

Fetomaternale Transfusion - Fetale Anämie - Intrauterine Transfusion - Fetales blood sampling

• References

• 1 Heise RH, van Winter JT, Ogburn PL. Identification of acute transplacental hemorrhage in a low risk patient as a result of daily counting of fetal movements. Mayo Clin Proc 1993; 68: 892-894
• 2 Bellussi F, Perolo A, Ghi T. et al. Diagnosis of severe fetomaternal hemorrhage with fetal cerebral Doppler: Case series and systematic review. Fetal Diagn Ther 2017; 41: 1-7
• 3 Wylie BJ, D'Alton ME. Fetomaternal hemorrhage. Obstet Gynecol 2010; 115: 1039-1051
• 4 Sadovsky G, Visser GH, Nicolaides KH. Heart rate patterns in fetal anemia. Fetal Ther 1988; 3: 216-223
• 5 Hernandez-Andrade E, Scheier M, Dezerega V, Carmo A, Nicolaides KH. Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops. Ultrasound Obstet Gynecol 2004; 23: 442-445
• 6 Weisberg L, Kingdom J, Keating S. et al. Treatment options in fetomaternal hemorrhage: four case studies. J Obstet Gynaecol Can 2004; 26: 893-898
• 7 Kim YA, Makar RS. Detection of fetomaternal hemorrhage. Am J Hematol 2012; 87: 417-423
• 8 Langlois S, Wilson RD. Non-invasive prenatal fetal testing by analysis of maternal blood. Clin Invest Med 1993; 16: 333-338
• 9 Nord E, Blaschke E, Green K. et al. 100 cases of external cephalic version, with special reference to fetomaternal transfusion. Acta Obstet Gynecol Scand 1989; 68: 55-58
• 10 Renaer M, van de Putte I, Vermylen C. Massive feto-maternal hemorrhage as a cause of perinatal mortality and morbidity. Eur J Obstet Gynecol Reprod Biol 1976; 6: 125-140
• 11 Bickers RG, Wennberg RP. Fetomaternal transfusion following trauma. Obstet Gynecol 1983; 61: 258-259
• 12 Solomonia N, Playforth K, Reynolds EW. Fetal-maternal hemorrhage: a case and literature review. AJP Rep 2012; 2: 7-14
• 13 German Society for Gynecology and Obstetrics (DGGG), Austrian Society for Gynecology and Obstetrics (OEGGG), Swiss Society for Gynecology and Obstetrics (SGGG). Prevention and Therapy of Preterm Birth. Version 5.0. Available from: https://register.awmf.org/de/leitlinien/detail/015-025. Date accessed: 01.11.2023